Does personality play a role in continuous positive airway pressure compliance?

Key points Continuous positive airway pressure (CPAP) adherence is low among individuals with obstructive sleep apnoea. Type D personality and high scores on the depression and hypochondriasis scales on the Minnesota Multiphasic Personality Inventory (MMPI) have been identified as factors contributing to non-compliance with CPAP. Further research into personality type may assist in understanding why some people adhere to CPAP, while others fail. Obstructive sleep apnoea (OSA) is a condition characterised by repetitive, intermittent partial or complete collapse/obstruction of the upper airway during sleep. Continuous positive airway pressure (CPAP) is highly efficacious in treating OSA but its effectiveness is limited due to suboptimal acceptance and adherence rates, with as many as 50% of OSA patients discontinuing CPAP treatment within the first year. Until recently, research has focused on examining mechanistic and demographic factors that could explain nonadherence (e.g. age, sex, race and education level) with limited applicability in a prospective or clinical manner. More recent research has focused on personality factors or types of patients with OSA who comply and do not comply with CPAP adherence in an attempt to enhance the accuracy of predicting treatment compliance. Type D personality has been found to be prevalent in one third of patients with OSA. The presence of Type D personality increases noncompliance and poor treatment outcomes due to negative affectivity, social inhibition, unhealthy lifestyle, and a reluctance to consult and/or follow medical advice. Conversely, individuals who are more likely to adhere to CPAP treatment tend to have a high internal locus of control and high self-efficacy, self-refer for treatment, and have active coping skills. By assessing personality and coping skills, the clinician may gain insight into the likelihood of a patient’s adherence to treatment. If the patient displays potential risk factors for CPAP noncompliance, the clinician can offer the patient education, refer them to a support group, engage in behavioural/motivational therapy and undertake regular follow-up visits or phone calls incorporating troubleshooting to increase CPAP adherence, especially in individuals with Type D personality

Misdiagnosis of narcolepsy

BACKGROUND: Narcolepsy is a chronic primary sleep disorder, characterized by excessive daytime sleepiness and sleep dysfunction with or without cataplexy. Narcolepsy is uncommon, with a low prevalence rate which makes it difficult to diagnose definitively without a complex series of tests and a detailed history. The aim of this study was to review patients referred to a tertiary sleep centre who had been labelled with a diagnosis of narcolepsy prior to referral in order to assess if the diagnosis was accurate, and if not, to determine the cause of diagnostic misattribution. METHODS: All patients seen at a sleep centre from 2007–2013 (n = 551) who underwent detailed objective testing including an MSLT PSG, as well as wearing an actigraphy watch and completing a sleep diary for 2 weeks, were assessed for a pre-referral and final diagnosis of narcolepsy. RESULTS: Of the 41 directly referred patients with a diagnostic label of narcolepsy, 19 (46 %) were subsequently confirmed to have narcolepsy on objective testing and assessment by a sleep physician using ICSD-2 criteria. CONCLUSIONS: The diagnosis of narcolepsy was incorrectly attributed to almost 50 % of patients labelled with a diagnosis of narcolepsy who were referred for further opinion by a variety of specialists and generalists. Accurate diagnosis of narcolepsy is critical for many reasons, such as the impact it has on quality of life, driving, employment, insurance and pregnancy in women as well as medication management

Emotion concepts and self-focused attention: Exploring parallel effects of emotional states and emotional knowledge. Motivation and Emotion

. (2006). Emotion concepts and selffocused attention: Exploring parallel effects of emotional states and emotional knowledge. Motivation and Emotion, 30,[225][226][227][228][229][230][231] Made available courtesy of Springer Verlag: http://www.springer.com/psychology/journal/11031 The original publication is available at www.springerlink.com ***Note: Figures may be missing from this format of the document Abstract: Many experiments have found that emotional experience affects self-focused attention. Several approaches to cognition and emotion predict that conscious emotional experience may be unnecessary for this effect. To test this hypothesis, two experiments primed emotion concepts without affecting emotional experience. In Experiment 1, subliminal exposure to sad faces (relative to happy faces and neutral faces) increased selffocused attention but not subjectively experienced affect. In Experiment 2, a scrambled-sentences task that primed happy and sad emotion concepts increased self-focused attention relative to a neutral task. Thus, simply activating knowledge about emotions was sufficient to increase self-focused attention. The discussion considers implications for research on how emotional states affect self-awareness. Keywords Emotion -Self-awareness -Emotion concepts -Self-focused attention -Cognition and emotion Article: Many studies find that manipulating emotional states causes changes in self-focus Are emotions necessary for emotional effects on self-focused attention? All of the models of emotions and self-focus assume that the subjective experience of emotion affects selffocused attention. Recent research in cognition and emotion, however, suggests that these effects could appear without conscious affective experience. Models of affect-as-information Models of unconscious affect also predict emotional effects on cognition in the absence of consciously experienced emotion. Finally, research on emotion concepts suggests that semantic priming processes could cause emotion-like effects on self-focused attention. People's knowledge about emotions-their semantic concepts of emotionscontain information about what emotions are like, the kinds of circumstances associated with certain emotions, and similarities between emotions (Innes- The present experiments Three related areas of research-affect as information, unconscious affect, and emotion concepts-suggest that subjective emotional experience isn't necessary for emotional effects on cognition and action. The present experiments tested whether emotional knowledge can affect self-awareness in the absence of emotional experience. In each study, participants completed a task that primed happiness or sadness, or they completed or a neutral task that did not prime emotions. Emotion concepts were primed with subliminal facial expressions of emotion (Experiment 1) or with a scrambled sentence task (Experiment 2). The priming tasks should not affect subjective emotional experience, but they should activate emotion-specific knowledge. Self-awareness and emotional experience were measured after the priming tasks. We expect (1) that priming happy and sad emotion concepts, relative to neutral priming, will increase self-focused attention, and (2) that this effect will appear despite no changes in subjective emotional experience. Experiment 1 Method Participants and design Seventy people enrolled in general psychology at the University of North Carolina at Greensboro (UNCG) participated and received credit toward a research option. Five participants were excluded-one person had heard about the subliminal manipulation from a prior participant, another person saw the subliminal faces, and three people failed to understand or follow the instructions. This left a final sample of 65 participants (52 females and 13 males). Each participant was randomly assigned to one of three between-person conditions: happy priming, neutral priming, or sad priming. Procedure Each person participated individually. The experimenter explained that the experiment was about personality and cognition. People expected to complete cognitive tasks followed by some measures of personality. A pretask baseline measure of mood was obtained with the Brief Mood Introspection Survey (BMIS; People worked on a computer-based perceptual matching task, in which they indicated whether two letters were the same or different (e.g., Proctor & Rao, 1983). This filler task provided a context for repeatedly presenting facial expressions of emotion. The experimenter explained that the study was interested in how mild distractions affected cognitive performance. Thus, each trial would begin with a fixation cross, a brief random pattern as an ostensible distraction, and then the letter-matching trial. In fact, following the fixation cross, a face was presented for 13 ms and then followed by a random pattern mask for 200 ms. Four happy, neutral, and sad facial expressions (half male, half female) were taken from the Ekman and Friesen (1978) set. Participants completed 54 trials, and a face was presented before each trial. The presentation and timing were controlled with SuperLab Pro (Version 2.0.4; Cedrus, 2003). Dependent measures Self-focused attention. Following the priming manipulation, people completed a -second cognitive task,‖ actually a measure of self-focus. The -Linguistic Implications Form‖ has 20 incomplete sentences that must be completed by choosing one of three pronouns Subjective emotional experience. To assess possible changes in mood as a function of the priming manipulation, we administered the BMIS after the measure of self-focused attention. This enabled an analysis of change in PA and NA as a function of the priming manipulation. Results Priming effects on self-focused attention If priming emotion concepts influences self-awareness, then people in the happy priming and sad priming conditions should be more self-focused than people in the neutral priming condition. To test this hypothesis, we conducted a planned contrast that compared the happy priming and sad priming conditions against the neutral priming condition (weights: 1, 1, −2). This contrast was not significant, t(62)=1.43, p < .16. Because the planned pattern did not appear, we conducted a one-way ANOVA, which found significant variability between the groups, F(2, 62)=2.96, p < .059. Priming effects on subjective experience Did the priming manipulation affect subjectively experienced affect? A 3 (priming manipulation: happy, neutral, sad) by 2 (time: pre, post) by 2 (affect: PA, NA) ANOVA assessed whether PA and NA changed over the experiment due to the priming manipulation. This analysis found only a main effect for affect (F(1, 62)=111, p < .001) and a main effect for time (F(1, 62)=8.41, p < .005). All other effects were not significant, Fs < 1. The time main effect reflected an overall decline in both PA and NA over the course of the experiment, probably because of boredom; the affect main effect reflected higher PA than NA at both time periods. Discussion Experiment 1 offered qualified support for our predictions. First, congruent with our predictions, activating emotion concepts with subliminal exposure to emotional expressions did not affect subjective emotional experience. Second, priming sad concepts significantly increased self-focus relative to neutral concepts. No effect was found for the happy priming condition, however, and we had expected that both the happy and sad conditions would show higher self-focus than the neutral condition. The asymmetry between happy and sad concepts might stem from the use of faces to prime emotional information. Recent research shows that happy faces are easier to process than other expressions Experiment 2 Experiment 2 conceptually replicated Experiment 1 by using a different priming manipulation. Happy, sad, and neutral emotion concepts were primed with a semantic priming task that did not involve facial expressions. Participants completed a scrambled-sentences task that was developed to prime happy and sad emotion concepts As before, we predicted that priming happy and sad emotion concepts would increase self-focused attention. Method Participants and design Sixty undergraduate women enrolled in general psychology at UNCG participated as part of a research option. Two people were excluded for not speaking English natively or for not adhering to the instructions, leaving a final sample of 58. Each person was randomly assigned to one of three between-subject conditions: happy priming, neutral priming, or sad priming. Procedure People participated in groups of six to eight. A female experimenter explained that the study was about -how people process complex and ambiguous language.‖ The participants expected to complete two -linguistic tasks‖ along with other questions. People first completed a single-item bipolar mood scale. This item asked -How would you describe your current mood?‖ People responded using an 11-point scale ranging from −5 to +5 (endpoints: very negative, very positive). A brief measure was used to avert suspicion about the study's true purposes. The first -linguistic task‖ was the manipulation of emotion priming. Participants completed a scrambledsentences task developed by Innes-Ker and Niedenthal Dependent measures All participants completed the 20-item pronoun-selection measure of self-focused attention upon finishing the scrambled sentences task Results Data reduction Self-focus scores were computed as the percentage of sentences completed with the self-focused option. The distribution of scores deviated from normality, and the variances differed significantly between some conditions (see Priming effects on self-focused attention If priming emotion concepts influences self-awareness, then people in the happy priming and sad priming conditions should be more self-focused than people in the neutral priming condition. To test this hypothesis, we conducted a planned contrast that compared the happy priming and sad priming conditions against the neutral priming condition (weights: 1, 1, −2), using the rank-transformed self-awareness scores. This contrast was significant, t(53)=2.64, p < .011. Mann-Whitney nonparametric tests examined the pattern of effects. People in the happy priming condition were more self-focused relative to people in the neutral condition, M-W Z=2.11, p < .035. Furthermore, people in the sad priming condition were more self-focused relative to people in the neutral condition, M-W Z=2.26, p < .024. The happy priming and sad priming conditions did not differ, M-W Z < 1, ns. Priming happy and sad emotion concepts thus increased self-awareness relative to priming neutral concepts. Priming effects on emotional experience Did priming emotional concepts affect emotional experience? We first analyzed the bipolar measure of affect (see Discussion Experiment 2 fully supported our predictions. As expected, priming happy and sad emotion concepts increased self-focused attention relative to priming neutral concepts. Moreover, the priming manipulation did not affect subjective emotional experience. Thus, evidence was found for a conceptual effect of emotional knowledge on self-focused attention. General discussion Positive and negative emotions reliably increase self-awareness The present experiments were designed to examine the possibility of conceptual effects on self-focus, not to decisively distinguish between the three possible explanations for why emotion priming could affect selffocused attention. The experiments and their findings, however, suggest that some of the explanations are more plausible than others. The affect-as-information model Models of emotion concepts seem to be the most promising of the three explanations. If people's concepts of emotions contain information about the self, then activating the emotion concepts should increase the activation of self-relevant information. As a result, activating emotional knowledge should incidentally activate selfknowledge, which would appear as higher scores on measures of self-focused attention. This approach fits both experiments, and it offers the most straightforward explanation for why emotion priming should affect selffocused attention. Nevertheless, the present experiments did not directly contrast the three possible explanations, so it remains for future research to examine how conceptual and experiential aspects of emotion influence self-focused attention. Acknowledgments We thank Åse Innes-Ker and Paula Niedenthal for providing the scrambled sentences used in Experiment 2 and Will Krause for assistance with data collection. This research was presented at the 2004 meeting of the Midwestern Psychological Association and at the 2005 meeting of the Society for Personality and Social Psychology. The measures of self-awareness are available a